Prof Stephen Tollman
The Agincourt Health and Socio-Demographic Surveillance System (HDSS) is the research foundation of the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt). The Unit’s work serves to strengthen and extend a high-functioning health and socio-demographic surveillance system, including annual census, vital events and socio-economic updates. This serves as the scientific foundation for a programme of advanced research and intervention studies.
Work in Agincourt passed through several stages following a baseline census in 1992:
- Decentralised health systems development (1993‑1997), providing a prototype for national policy in response to limited experience delivering rural services
- Reorientation to a university-linked health and population research initiative (1998‑2002) as serious weaknesses in the rural evidence base became apparent
- Establishment of a field-based research and training programme linked with Wits University (2003 onwards) that is central to an interdisciplinary university initiative ‘Population, Health and Society’
The mandate of the Unit is to better understand the dynamics of health, population and social transitions in rural South (and southern) Africa, in order to mount a more effective public health, public sector and social response.
The Unit provides a critical research platform for a programme of work to elucidate causal pathways and test interventions that address national priorities, but with a regional orientation. A life-course perspective serves as the framework for much of the Unit’s research. This programme supports advanced research training and develops systems to render data more widely available.
The MRC/Wits-Agincourt study site constitutes a sub-district of Bushbuckridge district, Mpumalanga Province, close to the Mozambique border (Fig 1) – some 30% of inhabitants are former Mozambican refugees. The study site has 31 villages with 18 500 households and 115 000 people. Infrastructure remains limited: there is no formal sanitation, piped water to communal standpipes is erratic and electricity is affordable to a minority. High unemployment results in temporary labour migration of men and women. There are two health centres: one private health centre and seven satellite clinics in the site; and three district hospitals are 25‑60 km away.
Figure 1: Southern Africa showing Agincourt study site; Agincourt study site detail, 2013.
View the MRC/Wits Rural Public Health and Health Transitions Research Unit's (Agincourt) Website